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Craddock LC, Hodson J, Gosling A, Cooper S, Morse RP, Begg P, Prokopiou A, Irving RM. Comparison of an Implantable Middle Ear Microphone and Conventional External Microphone for Cochlear Implants: A Clinical Feasibility Study. Otol Neurotol 2022; 43:1162-1169. [PMID: 36240742 PMCID: PMC7613807 DOI: 10.1097/mao.0000000000003713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES All commercially available cochlear implant (CI) systems use an external microphone and sound processor; however, external equipment carries lifestyle limitations. Although totally implantable devices using subcutaneous microphones have been developed, these are compromised by problems with soft tissue sound attenuation, feedback, and intrusive body noise. This in vivo pilot study evaluates a middle ear microphone (MEM) that aims to overcome these issues and compares hearing performance with that of an external CI microphone. DESIGN Six adult participants with an existing CI were implanted with a temporary MEM in the contralateral ear. Signals from the MEM were routed via a percutaneous plug and cable to the CI sound processor. Testing was performed in the CI microphone and MEM conditions using a range of audiometric assessments, which were repeated across four visits. RESULTS Performance of the MEM did not differ significantly from that of the CI on the assessments of Auditory Speech Sounds Evaluation loudness scaling at either 250 or 1000 Hz, or in the accuracy of repeating keywords presented at 70 dB. However, the MEM had significantly poorer aided sound-field thresholds, particularly at higher frequencies (≥4000 Hz), and significantly poorer performance on Arthur Boothroyd words presented at 55 dB, compared with the CI. CONCLUSION In this pilot study, the MEM showed comparable performance to that of an external CI microphone across some audiometric assessments. However, performance with the MEM was poorer than the CI in soft-level speech (55 dB) and at higher frequencies. As such, the benefits of MEM need to be considered against the compromises in hearing performance. However, with future development, MEM is a potentially promising technology.
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Affiliation(s)
| | - James Hodson
- University Hospitals Birmingham NHS Foundation Trust, UK
- Health Data Science Team, Research Development and Innovation, Institute for Translational Medicine, University Hospitals Birmingham NHS Foundation Trust
| | - Amy Gosling
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - Stacey Cooper
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | - Philip Begg
- University Hospitals Birmingham NHS Foundation Trust, UK
- University of Kentucky, USA
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Ismail O, Sobhy O, Assal S, Sanghera P, Begg P, Irving R. Comparing Hearing Outcomes in Irradiated and Conservatively Managed Vestibular Schwannoma. Otol Neurotol 2022; 43:e374-e381. [PMID: 35061638 DOI: 10.1097/mao.0000000000003457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compare hearing outcome for vestibular schwannoma patients following stereotactic radiosurgery (SRS) or conservative management. STUDY DESIGN Retrospective review. SETTING University Hospital. PATIENTS Patients with small- or medium-sized sporadic vestibular schwannoma (intracanalicular or with CPA component <2 cm) who were managed conservatively or underwent SRS with available clinical, radiological, and audiometric data from the time of presentation (or just before radiotherapy for the SRS group) and most recent follow-up; with the two sets of data to be compared being at least 3 years apart (minimum follow-up period). INTERVENTIONS SRS or observation. MAIN OUTCOME MEASURE Pure-tone averages, speech discrimination scores, and corresponding hearing classifications. RESULTS Two hundred forty-seven patients met our inclusion criteria; 140 were managed conservatively with a mean follow-up period of 5.9 ± 1.6 years and 107 underwent SRS with a mean follow-up period of 7.1 ± 1.9 years. There was significant deterioration of hearing measures for both groups; with the SRS group displaying consistently worse measures. SRS patients showed worse mean pure-tone averages and speech discrimination scores decline rates by 2.72 dB/yr and 2.98 %/yr, respectively, when compared with conservatively managed patients. Stratifying patients according to Tokyo's hearing classification revealed that 68.75% of conservatively managed patients who had baseline serviceable hearing preserved their hearing throughout the studied period compared with only 15.38% of the SRS patients. CONCLUSION Based on our data we conclude that patients with small- and medium-sized tumors will have a better hearing outcome if managed via an initial conservative approach with radiotherapy reserved for those demonstrating disease progression.
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Affiliation(s)
- Omneya Ismail
- Otolaryngology Department-Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Otolaryngology Department-Audiovestibular Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ossama Sobhy
- Otolaryngology Department-Audiovestibular Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samir Assal
- Otolaryngology Department-Audiovestibular Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Paul Sanghera
- Clinical Oncology Department, Queen Elizabeth Hospital Birmingham
| | - Philip Begg
- Otolaryngology Department-Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- The Royal Orthopaedic Hospital NHS Foundation Trust
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Richard Irving
- Otolaryngology Department-Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Hafeez N, Du X, Boulgouris N, Begg P, Irving R, Coulson C, Tourrel G. Electrical impedance guides electrode array in cochlear implantation using machine learning and robotic feeder. Hear Res 2021; 412:108371. [PMID: 34689069 DOI: 10.1016/j.heares.2021.108371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 09/22/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Cochlear Implant provides an electronic substitute for hearing to severely or profoundly deaf patients. However, postoperative hearing outcomes significantly depend on the proper placement of electrode array (EA) into scala tympani (ST) during cochlear implant surgery. Due to limited intra-operative methods to access array placement, the objective of the current study was to evaluate the relationship between EA complex impedance and different insertion trajectories in a plastic ST model. A prototype system was designed to measure bipolar complex impedance (magnitude and phase) and its resistive and reactive components of electrodes. A 3-DoF actuation system was used as an insertion feeder. 137 insertions were performed from 3 different directions at a speed of 0.08 mm/s. Complex impedance data of 8 electrode pairs were sequentially recorded in each experiment. Machine learning algorithms were employed to classify both the full and partial insertion lengths. Support Vector Machine (SVM) gave the highest 97.1% accuracy for full insertion. When a real-time prediction was tested, Shallow Neural Network (SNN) model performed better than other algorithms using partial insertion data. The highest accuracy was found at 86.1% when 4 time samples and 2 apical electrode pairs were used. Direction prediction using partial data has the potential of online control of the insertion feeder for better EA placement. Accessing the position of the electrode array during the insertion has the potential to optimize its intraoperative placement that will result in improved hearing outcomes.
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Affiliation(s)
- Nauman Hafeez
- Institute of Environment, Health and Societies, Brunel University, London, UB8 3PH, UK.
| | - Xinli Du
- Institute of Environment, Health and Societies, Brunel University, London, UB8 3PH, UK
| | - Nikolaos Boulgouris
- Institute of Environment, Health and Societies, Brunel University, London, UB8 3PH, UK
| | - Philip Begg
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Richard Irving
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Chris Coulson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
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Hou L, Du X, Boulgouris NV, Hafeez N, Coulson C, Irving R, Begg P, Brett P. A Capacitive Cochlear Implant Electrode Array Sensing System to Discriminate Fold-Over Pattern. J Speech Lang Hear Res 2021; 64:3685-3696. [PMID: 34407380 DOI: 10.1044/2021_jslhr-21-00067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose During insertion of the cochlear implant electrode array, the tip of the array may fold back on itself and can cause serious complications to patients. This article presents a sensing system for cochlear implantation in a cochlear model. The electrode array fold-over behaviors can be detected by analyzing capacitive information from the array tip. Method Depending on the angle of the array tip against the cochlear inner wall when it enters the cochlear model, different insertion patterns of the electrode array could occur, including smooth insertion, buckling, and fold-over. The insertion force simulating the haptic feedback for surgeons and bipolar capacitance signals during the insertion progress were collected and compared. The Pearson correlation coefficient (PCC) was applied to the collected capacitive signals to discriminate the fold-over pattern. Results Forty-six electrode array insertions were conducted and the deviation of the measured insertion force varies between a range of 20% and 30%. The capacitance values from electrode pair (1, 2) were recorded for analyzing. A threshold for the PCC is set to be 0.94 that can successfully discriminate the fold over insertions from the other two types of insertions, with a success rate of 97.83%. Conclusions Capacitive measurement is an effective method for the detection of faulty insertions and the maximization of the outcome of cochlear implantation. The proposed capacitive sensing system can be used in other tissue implants in vessels, spinal cord, or heart.
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Affiliation(s)
- Lei Hou
- Brunel University London, United Kingdom
| | - Xinli Du
- Brunel University London, United Kingdom
| | | | | | - Chris Coulson
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, United Kingdom
| | - Richard Irving
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, United Kingdom
| | - Philip Begg
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, United Kingdom
| | - Peter Brett
- University of Southern Queensland, Toowoomba, Australia
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Abstract
Background An arm supported robotic drill has been recently demonstrated for preparing cochleostomies in a pilot research clinical trial. In this paper, a hand-guided robotic drill is presented and tested on human cadaver trials. Methods The innovative smart tactile approach can automatically detect drilling mediums and decided when to stop drilling to prevent penetrating the endosteum. The smart sensing scheme has been implemented in a concept of a hand guided robotic drill. Results Experiments were carried out on two adult cadaveric human bodies for verifying the drilling process and successfully finished cochleostomy on three cochlea. The advantage over a system supported by a mechanical arm includes the flexibility in adjusting the trajectory to initiate cutting without slipping. Using the same concept as a conventional drilling device, the user will also be benefit from the lower setup time and cost, and lower training overhead. Conclusion The hand-guided robotic drill was recently developed for testing on human cadavers. The robotic drill successfully prepared cochleostomies in all three cases.
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Affiliation(s)
- Xinli Du
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK,
| | - Peter N Brett
- University of Southern Queensland, Toowoomba, QLD, Australia
| | - Yu Zhang
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK,
| | - Philip Begg
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Chris Coulson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Irving
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Abstract
Totally implantable cochlear implants may be able to address many of the problems cochlear implant users have around cosmetic appearances, discomfort, and restriction of activities. The major technological challenges that need to be solved to develop a totally implantable device relate to implanted microphone performance. Previous attempts at implanting microphones for cochlear implants have not performed as well as conventional cochlear implant microphones, and in addition have struggled with extraneous body or surface contact noise. Microphones can be implanted under the skin or act as sensors in the middle ear; however, evidence from middle ear implants suggest body and contact noise can be overcome by converting ossicular chain movements into digital signals. This article reviews implantable microphone systems and discusses the technology behind them.
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Affiliation(s)
- Alistair Mitchell-Innes
- a University Hospital Birmingham NHS Foundation Trust , Mindelsohn Way, Edgbaston, Birmingham B15 2TH , UK
| | - Robert Morse
- b School of Engineering, University of Warwick , Library Road, Coventry , CV4 7AL , UK
| | - Richard Irving
- a University Hospital Birmingham NHS Foundation Trust , Mindelsohn Way, Edgbaston, Birmingham B15 2TH , UK
| | - Philip Begg
- a University Hospital Birmingham NHS Foundation Trust , Mindelsohn Way, Edgbaston, Birmingham B15 2TH , UK
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Wheeler C, Halter M, Drennan VM, de Lusignan S, Grant R, Gabe J, Gage H, Begg P, Ennis J, Parle J. Physician associates working in secondary care teams in England: Interprofessional implications from a national survey. J Interprof Care 2017; 31:774-776. [PMID: 28876145 DOI: 10.1080/13561820.2017.1341390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Physician associates (PAs) are a new type of healthcare professional to the United Kingdom; however, they are well established in the United States (where they are known as physician assistants). PAs are viewed as one potential solution to the current medical workforce doctor shortage. This study investigated the deployment of PAs within secondary care teams in England, through the use of a cross-sectional electronic, self-report survey. The findings from 14 questions are presented. Sixty-three PAs working in a range of specialties responded. A variety of work settings were reported, most frequently inpatient wards, with work generally taking place during weekdays. Both direct and non-direct patient care activities were reported, with the type of work undertaken varying at times, depending on the presence or absence of other healthcare professionals. PAs reported working within a variety of secondary care team staffing permutations, with the majority of these being interprofessional. Line management was largely provided by consultants; however day-to-day supervision varied, often relating to different work settings. A wide variation in ongoing supervision was also reported. Further research is required to understand the nature of PAs' contribution to collaborative care within secondary care teams in England.
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Affiliation(s)
- Carly Wheeler
- a Faculty of Health, Social Care and Education , Kingston University and St George's, University of London , London , UK
| | - Mary Halter
- a Faculty of Health, Social Care and Education , Kingston University and St George's, University of London , London , UK
| | - Vari M Drennan
- a Faculty of Health, Social Care and Education , Kingston University and St George's, University of London , London , UK
| | - Simon de Lusignan
- b Department of Clinical and Experimental Medicine , University of Surrey , Guildford , UK
| | - Robert Grant
- a Faculty of Health, Social Care and Education , Kingston University and St George's, University of London , London , UK
| | - Jonathan Gabe
- c Centre for Criminology and Sociology, School of Law, Royal Holloway , University of London , London , UK
| | - Heather Gage
- d School of Economics , University of Surrey , Guildford , UK
| | - Philip Begg
- e The Royal Orthopaedic Hospital Birmingham NHS Foundation Trust , Birmingham , UK
| | - James Ennis
- f Institute of Clinical Sciences , University of Birmingham , Birmingham , UK
| | - Jim Parle
- f Institute of Clinical Sciences , University of Birmingham , Birmingham , UK
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